The 41st Congress of the European Society of Cataract & Refractive Surgeons (ESCRS) was held in the prestigious Messe Wien Exhibition and Congress Centre, Vienna – the hometown of ESCRS’s own president Professor Oliver Findl (pictured below, presenting an award at the opening ceremony) – from September 8-12.
With a phenomenal 14,000 delegates in attendance on a fabulous sunny weekend, this year was a conference with a difference.
Delegates were given the opportunity to experience near live surgery, an active arena to participate in lively debate, with audiences moving across the floor to join those speakers whose ideas they were in favour of, and to keep the momentum going delegates danced the night away at a wonderful Viennese Charity Ball.
As in previous years, delegates were also given unprecedented opportunities for learning and networking, including access to almost 400 free papers, dozens of wet labs and instructional courses, hundreds of posters, and video sessions. The vast exhibition area gave unrivalled opportunities to meet with industry partners and socialise with colleagues.
The ESCRS Education Committee purchased an eye simulator to provide to regions where doctors have limited access to hands-on training. The simulators move from country to country with access overseen by local societies. A customised ESCRS curriculum for cataract surgery training is being developed to be delivered in lengthy sessions with an instructor available to help trainees.
At the meeting, there were hundreds of industry colleagues and a tempting array of lunchtime industry symposia where attendees were provided with the opportunity to learn and lunch.
Sustainability continues to be a key focus of the society and the annual meeting. New innovations and those on the horizon shared at ESCRS included an online Cat pack tool for evaluating the environmental sustainability of customised cataract packs used by hospitals and surgical centres.
In the Sustainability Arena, some of the most renowned international surgeons were challenged with tough questions from the next generation of ophthalmologists about what is being done to improve sustainability in ophthalmology. ESCRS Mission Zero strives to reduce the carbon footprint of the ESCRS.
This included the aim to eliminate 90% of single use plastic, polystyrene and PVC from its operations. The Society encouraged delegates to choose climate friendly transport and use locally sourced food.
A dedicated session in the main symposium ‘Making our Surgery Greener’ (panel pictured below) chaired by Prof Findl included a sobering presentation by Prof Hugh Montgomery OBE (pictured right) who helped attendees understand the scale of the problem and urged everyone to be part of the solution, ‘if we decarbonise healthcare, we decarbonise the world.’
The meeting began with speciality day events on cornea and glaucoma. Topics included new developments in keratoconus and crosslinking and updates in lamellar surgery and the historical contribution of Vienna to glaucoma. Delegates also participated in wet labs including Lasik, suturing, and glaucoma viscocanalostomy.
MIGS vs SLT in the Arena
A passionate debate unfolded in the interactive arena with Karl ‘the Jackal’ Mercieca from Germany in one corner against Carlos ‘Jackhammer’ Traverso from Italy in the other. They battled it out over the superiority and efficacy of the two glaucoma techniques complementary to cataract surgery: MIGS (Minimally Invasive Glaucoma Surgery) and SLT (Slit Lamp Trabeculectomy).
Dr Taverso exclaimed: ‘There is no comparable risk when we look at SLT.’ He advised the IOP reduction seen in MIGS is better than SLT and being able to combine the technique with phacoemulsification means that it is convenient and cost-effective. He added the technique is versatile and not limited by ocular co-pathology or the need for open angles. ‘It’s truly personalised medicine for your glaucoma patients’ he concluded.
Dr Mercieca fought back, advising the cost of dual surgery (MIGs and phacoemulsification) was not financially viable. He retorted MIGS is ineffective with delayed results (up to six weeks post-surgery) and demonstrated severe risks including post-operative endophthalmitis.
He advised cataract surgeons required something comparable to drops that was immediately effective and SLT was the solution most beneficial to the patient. He concluded: ‘My income grows steadily if I use MIGS, but I’m not there for income. I’m there for the patient’s wellbeing. So, I think that as a first step, SLT is really the only way out.’
To conclude the debate, the referee Dr Leon summed up the arguments, thanked the delegates for their contribution and declared Dr Mercieca the winner of the tightly fought contest.
Binkhorst Medal Lecture
This year’s heritage lecture was delivered by Prof Jorge L Alio entitled Corneal regeneration: the future of corneal surgery. Professor Alio relayed the treatment of corneal disease is advancing and this change will address many of the shortcomings of current treatment for corneal dystrophies and other sight-threatening conditions.
‘We are at the forefront of an exciting revolution in the treatment of corneal blindness, moving from the old paradigm of cornea tissue substitution to one where cornea tissue regeneration becomes the new standard,’ he said.
With 40,000 people with visual impairment waiting for corneal transplants in Europe, 10 million untreated corneal blindness patients globally and 1.5 million cases of corneal blindness annually, he advised there is a pressing need for novel treatments.
Highlighting some of the latest research in regenerative techniques for a wide range of corneal disease, it was suggested advanced stem cell therapy may be a game-changer.
Approaches such as using mesenchymal stem cells for ocular surface diseases such as dry eye and corneal burns were discussed. Adipose-derived stem cells (ADSCs) (derived from fat tissue) having undergone differentiation into epithelial and stromal cells have shown to be a viable cell source for stromal regeneration and repopulation in diseased corneas.
Looking forward, Prof Alio predicted that stem cell therapies could be the solution to the shortages in corneal tissue grafts. ‘This will improve patient quality of life and reduce the economic burden of corneal transplants on healthcare,’ he said. ‘Furthermore, we expect these bio-constructs to provide better therapeutic outcomes over donor corneas, such as avoiding allograft rejection.’
AI Advances in Ophthalmology
The rise and potential of artificial intelligence (AI) in ophthalmology was a hot topic at the ESCRS conference with lecture presentations delivered by colleagues from all over the globe, including Dr Beatrice Cochener-Lamard (France) Dr Gavin Tan (Singapore) and Dr Grayson Armstrong (USA).
Dr Siyin Liu MD, winner of this year’s John Henahan Writing Prize, also shared his discourse of the rise of AI.
In the wake of the Covid-19 pandemic, resources are strained and waiting lists growing. Ophthalmology has met this challenge with acceleration in tele-medicine and has been at the forefront of AI innovation, utilising deep learning in the treatment and management of ocular disease.
AI models have been validated for use with OCT, fundus photography and electronic patient records for risk stratification and disease diagnosis and management.
Primarily being focused on image-based deep learning, AI has been proven to be effective in the management of diabetes, glaucoma, and age-related macular degeneration (AMD). The potential of AI continues to be unlocked with recent advancements demonstrating the capabilities of using AI in anterior segment disease, including early detection of corneal ectasias and the diagnosis of infective keratitis, he shared.
Dr Liu concluded it is predicted by 2025 a whopping 85% of customer interactions will be managed without human agents. It is envisaged ophthalmology can further harness this technology and that natural language processing chat bots can be used to triage symptoms, monitor adherence to treatments and provide support to existing and limited ophthalmology services.
Ukraine
More than 572 days have passed since the invasion of Ukraine, with many lives lost and sadly the struggle continues. Ukraine ophthalmologists continue to bravely fight to save sight on the frontline. At this year’s ESCRS, almost 600 delegates from Ukraine were in attendance with a united voice of hope.
Dr Valerii Serdiuk shared his personal experience of the war, advising that thousands of military and civilian patients have been treated at Dnipropetrovsk Hospital since the outbreak of conflict.
He also shared that eye trauma accounts for 13% of all injuries in modern warfare. Dealing with ocular polytrauma requires rapid intervention to improve sight prospects in injured patients, he shared.
Prof Nadiia Ulianova also reported on her experience treating combat victims at the Filatov Institute of Eye Diseases and Tissue Therapy in Odesa. ‘Modern combat trauma is particularly severe and requires complex reconstructive treatment,’ she said.
She highlighted strategies to treat severe eye trauma, including extensive globe injuries and multiple foreign bodies. These including keratoprostheses, amniotic membrane and soft contact lenses used either individually or in combination with PPV.
Advances in refractive surgery
A session on ‘Presbyopia Game Changers’ reviewed the latest in pharmacological treatments (miotic agents), multifocal and extended depth of focus intraocular lenses, enhanced monofocals and mini-monovision, modification of intraocular lenses post-implantation, presbyopic laser solutions and presbyopic implantable contact lenses.
Prof Liliana Werner explained how residual refractive errors can be corrected after cataract surgery with a femtosecond laser. The technology enables the application of multifocality to monofocal lenses and similarly it can also be used to cancel multifocal patterns.
A survey looking at the trends and future of refractive surgery performed by refractive surgeons (ESCRS 2023) revealed there was an upward trend in the average annual volume of corneal refractive surgery cases.
Reporting on the results, Dr Beatrice Cochener-Lamard noted that there was an upward trend in the average annual volume of corneal refractive surgery cases performed between 2020 and 2022.
It was reported that most procedures performed were using excimer lasers, 12% were conducting a femtosecond laser intrastromal lenticule extraction and 54% were currently implanting phakic IOLs (intraocular lenses).
Dr Viktor Derhartunian from Austria advised that there are plenty of refractive solutions for patients, including LASIK, phakic IOLs and lenticule extraction. The plethora of options he described included lenticule extraction, useful in patients with myopia, mixed astigmatism and ,on the horizon, treatment for hyperopes.
He highlighted phakic IOLs are a good solution for patients at risk of corneal ectasia and higher degrees of myopia and hyperopia. ‘We now have a refractive solution for 99.9% of patients,’ he said.
Prof Walter Sekundo (Austria) shared the development update on hyperopic SMILE. This treatment is now on the horizon with the newer Visumax 800 laser offering advantages over previous technologies, including much faster treatment times.
Dr Rohit Shetty (India) introduced delegates to the new SILK lenticule extraction using the ELITA platform. He advised the unique bi-convex shape of the lenticule has a minimal impact on Bowman’s layer regularity, spherical aberration and, potentially, corneal nerves.
To conclude, Dr Roger Zaldivar (Argentina) reported that the EVO Visian ICL (phakic IOL) is a safe and efficacious refractive solution for many patients. He reported a jaw-dropping six billion people are estimated to have myopia of -6D or more by 2050, and six million people dropping out of contact lenses yearly, this would be a much-needed procedure to address these trends.
‘This is a very safe and effective procedure, and in my opinion, it will be the procedure that will grow the most in the next couple of years,’ he said.
In summary, this year was one of the best-attended Congresses to date and with its unique it format allowed for a memorable experience for all delegates in attendance.
As it is impossible to attend every session, a welcome feature of the ESCRS meetings for the most dedicated is that most sessions, free papers, posters and case reports are available on demand for ESCRS members and delegates so they can be reviewed after the event.
- Dr Nabila Jones is eye sciences research associate at Optegra Eye Health Care.
- Dr Clare O’Donnell is head of eye sciences & optometry at Optegra Eye Health Care.